寒战者，森然若寒，振振然摇动也。切牙者，上下片牙相磨而鸣也。经曰∶诸风振掉，皆属肝木。寒战而振振摇动，
风之众也，火气冲物亦然。钱氏曰∶肝主风，虚则切牙多欠。又曰∶上窜切牙，心热也。然则寒战切牙，心肝
二脏主之，或以寒战为气虚，切牙为血虚，或以切牙为齿槁，谓津液不足者，皆不知此意。痘疮所恶者寒战切牙，
或单见一证，或二证并见，若疮已坏，加之喘促闷乱者，死无日矣。凡病痘者，疮本稠密，转动之间，身体振摇者，此
一身被疮所困，不能支持，转动艰难之故，不可便作寒战，妄投热药也。有只切牙者，此心肝二经火旺也，盖肝虚
切牙，心热者亦切牙，勿便作不治论。
如疮初出而寒战者，此邪气将出，外与正争，故振振摇动，火之象也，疮出乃定，柴葛桂枝汤主之。疮已出，或
已成浆而寒战者，表气虚而不胜邪气之盛也，养卫化毒汤主之。如疮本稠密， 发肿痛，经脉动摇，时时振
动者，不可谓之寒战，待脓成痛去而解。收靥之时，痂皮圆净，但或时战栗者，此正气将复，不能
自持之兆，不必忧疑，须臾自定。有筋惕肉 者，经络之血为疮所耗，不能荣养肌肉，主持筋脉，故惕惕然而手足自
跳， 然而肤肉自动也，不可谓之寒战，但养其气血，十全大补汤（汗）主之。〔薛〕一小儿十四岁，痘将愈，忽
寒战手足并冷，脉微细而不及两寸。乃脾气虚热。用五味异功散、独参汤、十全大补汤而愈。一妇人，愈后寒战，
脉浮大，按之微细。此血气虚也，用十全大补汤三十余剂而愈。后因劳，寒热往来，寒时手足如水，热时手足如
炙，脉浮大，重按则细。此阳气虚甚也，朝用补中益气汤加桂、附各一钱，夕用八味丸料倍加桂、附，各五十余剂而安。
柴葛桂枝汤
柴胡 葛根 甘草 桂枝 防风 人参 白芍药（各等分）
上锉细。加生姜三片，水一盏，煎七分，去滓，温服，不拘时。
养卫化毒汤
人参 黄 （炙） 桂枝 甘草 当归
上，水煎服。
初虞世云∶憎寒困倦，或发寒战，能令痘子缩伏，宜用陈文中异功散（方见见形证治出不快条）。娄氏云∶
尝治痘疮寒战，用白术、 、归加芩治之愈。
〔袁氏〕独附汤 治寒战。
大附子（五钱，面裹煨）
用水一钟，灯草七根，煎服。
上方，加人参二钱、肉桂五分、黄 二钱、橘红一钱、甘草五分、当归一钱、则为附子振阴汤，治寒
战切牙捷效方也，但紫焦伏黑者不用。
切牙呵欠者，肝虚也，肝属木，临官于寅，寅为相火，火盗木之气，故肝虚之证形焉。阳引而上，阴引而下，
则开而欠也。阳上极而下，阴下极而上，则合而啮
也。十全大补汤主之。如发热之初，便切牙者，此与痒塌吐泻，脾胃弱者不同，须审形证分治之，若多欠切牙顿闷者，
肝藏风热也，羌活汤（痘发热）。目上窜切牙者，心脏热也，导赤散（心）。不可妄用陈氏辛热之剂。上窜切牙者，心热
也，诸疮皆属心火，上窜者，火炎上之象也，切牙者，火气动摇之象也，导赤散加酒炒黄连、牛蒡子主之。切牙兼面赤
作渴，至夜为甚者，宜地黄丸。〔薛〕一小儿痘疮切牙，面黄饮汤。此阳气虚弱也。用五味异功散加木香而愈。后仍切牙，
面赤作渴，至夜为甚。此脾肾阴虚也。用地黄丸、大补汤而愈。一小儿切牙作渴，面色忽白忽赤，脉洪数，按之无力，
左关尺为甚。此属肾虚也。用地黄丸、补中益气汤寻愈。后因惊面青目赤，呵欠切牙，手寻衣领。此肝经虚热。用加减
八味丸料煎与恣饮，顿安，又用补中益气汤而痊。一小儿切牙，作渴饮冷，大便微秘，寒战痘赤，多在身侧。此属
胆经虚热也。用小柴胡汤、柴胡麦门散各一剂，又用加味四物汤而痊。
清神化毒汤 治心肝火旺，其牙相戛而鸣者。
升麻 生地黄 木通 甘草 防风 麦门冬
上，用水煎服。
人参蝉蜕散 治切牙喘满，烦躁作渴（方见痘烦躁）。
〔钱氏〕百神丸 治戛齿甚妙。
如寒战、切牙并作者，则少阴专主之，观其疮本。如疮本溃烂，寒战切牙者，此手少阴心火也。经曰∶热胜
则肉腐。寒战切牙，火气动摇之象也。如疮本焦黑，寒战切牙者，此足少阴肾水也，肾色黑，为主蛰封藏之本，干
黑者真藏色见也。肾气寒，在变动为栗，寒战者，肾本病也。肾主骨，牙为骨余，寒战则鼓颔而两牙相
轧，切牙者，肾寒所发也。此二证者，在心热则清之，在肾寒则温之，其病已坏，治之何益。或因阳气亏损，切牙
寒战者，独参汤、参附汤甚效。若血气不荣，而不能靥，兼以闷乱不宁，卧则哽气，泄泻寒战切牙者，陈氏异功散（
见形出不快条）加木香、当归以救之。钱氏法，寒战切牙黑陷者，百祥丸下之（方见黑陷）。〔薛〕前证，若手足并冷，
渴饮热汤，大便泄泻者，阳气虚寒也，宜热补之。手足不冷，大便不利，渴饮温汤者，脾气虚热也，宜调补之。手
足不热，大便不利，渴饮热汤者，脾胃虚弱也，宜温补之。一小儿出痘，寒战切牙，四肢倦缩，大便自利，手足并
冷，喜饮热汤。此阳气虚寒也。用十二味异功散末二钱，诸证顿退，又用人参白术散、参
四圣散而靥。一小儿十四岁，面色忽赤忽黑，出痘寒战切牙，作渴烦热，喜饮热汤。此阳气虚寒也。用十全大补汤散，
烦渴顿止，乃以八珍倍加参、 。至脓灌，又作渴面赤，此脓成而血气虚也，用当归补血汤、八珍汤而靥。至月余，
面赤烦渴，或时昏愦，痘痕如赭，或时作痒，脉洪大，按之如无。此血脱也，用大剂当归补血汤而安。一小儿脓不
灌，兼寒战切牙，腹胀。属脾胃虚弱。用四君、肉桂、归、 、肉豆蔻，又用参 四圣散而痊，后用托里散、四君
子汤而靥。一小儿痒塌，寒战切牙，喜饮温汤，手足不热。属阳气虚弱也。用参 四圣散，诸证已退，用参 托
里散，其浆渐灌，用十全
大补汤，其痂顿靥。一产妇出痘，寒战切牙，腹胀作渴，足冷身热。此脾胃，内虚寒外假热也，大补汤加桂、附三四
剂，去附，易干姜二三剂，仍用参 四圣散并五味异功散加归、 治之而痊。
诸书多以寒战切牙并作，为不治之证，然能善治之，多有生者，盖热毒不得尽发，内与正气相搏，则筋脉因
之而动摇，人之一身，惟手足能运动，口能开阖，皆虚境也，相搏之际，故手足战摇，而口齿相戛矣。
无忧散 治临危痘证，寒战切牙。
人牙（自落者、不拘多少，火 存性，淬入韭菜汁内，大牙三次，小牙二次，研极细末） 雄黄 珍珠（各五分）
上，俱研为末。每服三五分，多则一钱，用荔枝煎汤下。一方，有牛黄五分。
透骨解毒汤 治寒战切牙。
紫草 甘草 当归 防风 陈皮 赤芍药
上，各等分，水煎服。
催蛰丹 痘逾八九朝，脓浆虽不充裕，倏然寒战切牙，以此治之。
虎牙、人牙、各一枚，酥炙，研细，和人参、丁香末、乳、酒和服。
滴滴金 治寒战切牙。
狗头去肉留脑髓，酥炙脆，细研为末，浓煎酒，下。
Chanzhan (Shivering with cold) refers to the symptom where the body feels cold and trembles violently. Qieya (Teeth grinding/clenching) refers to the symptom where the upper and lower teeth rub against each other, producing a sound. The classics state: All tremors and shaking caused by wind pathogen belong to the Liver Wood system. Chanzhan accompanied by violent shaking is a manifestation of excessive Wind; similarly, the agitation of objects caused by surging Fire Qi follows the same principle. Qian Yi stated: The Liver governs Wind; deficiency of the Liver leads to teeth clenching and frequent yawning. He also stated: Eyes rolling upward accompanied by teeth clenching indicates Heart Heat. Therefore, Chanzhan and Qieya are primarily governed by the Heart and Liver organs. Some attribute Chanzhan to Qi deficiency and Qieya to Blood deficiency; or they consider Qieya as due to withered teeth caused by insufficient Body Fluids. These views fail to understand the underlying pathology. In smallpox, the feared symptoms are Chanzhan and Qieya. They may appear singly or simultaneously. If the rash has deteriorated and is accompanied by panting, distress, and confusion, death is imminent. For patients with smallpox, if the rash is originally dense, and the body shakes during turning movements, this is because the whole body is constrained by the toxin, and the righteous Qi cannot support it, making movement difficult. This should not be simply diagnosed as Chanzhan, nor should hot-natured medicines be blindly administered. Cases presenting only with Qieya are due to excessive Fire in the Heart and Liver meridians. Since Liver deficiency causes Qieya and Heart Heat also causes Qieya, one should not hastily conclude it is an incurable condition.
If Chanzhan occurs when the smallpox rash first emerges, it indicates that the pathogenic factor is attempting to exit and is contending with the righteous Qi, causing trembling. This is a sign of Fire. The symptoms will subside once the rash erupts. The primary formula is Chaige Guizhi Tang. If Chanzhan persists after the rash has emerged or even when pustules have formed, it indicates deficiency of the Exterior Qi, which cannot withstand the excess pathogen. The primary formula is Yangwei Huadu Tang. If the rash was originally dense, accompanied by swelling, pain, meridian instability, and constant trembling, this is not Chanzhan; one should wait for suppuration and pain resolution for natural relief. During the scabbing stage, if the scabs are round and clean but occasional shivering occurs, this is a sign that the righteous Qi is recovering but lacks self-control; there is no need to worry, as it will settle shortly. Symptoms of Jin Ti Rou Dong (muscle twitching/fasciculation) occur because the blood in the meridians is depleted by the toxin, failing to nourish muscles and tendons, causing involuntary jumping of the limbs and automatic twitching of the skin and flesh. This is not Chanzhan; treatment should focus on nourishing Qi and Blood using Shiquan Dabu Tang (applicable if sweating is present). Xue Ji recorded a case of a 14-year-old boy whose smallpox was nearly cured when he suddenly experienced Chanzhan and cold extremities, with a faint, thin pulse below the cun position. This was attributed to Spleen Qi deficiency with heat. He recovered after using Wuwei Yigong San, Dushen Tang, and Shiquan Dabu Tang. A woman experienced Chanzhan after recovery from smallpox; her pulse was floating and large but faint upon deep pressure, indicating Qi and Blood deficiency. She recovered after taking over thirty doses of Shiquan Dabu Tang. Later, due to overwork, she experienced alternating chills and fever; her hands and feet were cold as water during chills and hot as fire during fever, with a floating, large pulse that became thin upon deep pressure. This indicated severe Yang Qi deficiency. She took Buzhong Yiqi Tang with Guizhi and Fuzi (each 1 qian) in the morning, and Bawei Wan formulation with doubled Guizhi and Fuzi in the evening, taking over fifty doses of each until stabilized.
Chaige Guizhi Tang
Ingredients: Chaihu, Gegen, Gancao, Guizhi, Fangfeng, Renshen, Baishao (all in equal proportions).
Preparation: Coarsely crush. Add three slices of Shengjiang, one cup of water, decoct to seven-tenths volume, strain, and take warm at any time.
Yangwei Huadu Tang
Ingredients: Renshen, Huangqi (roasted), Guizhi, Gancao, Danggui.
Preparation: Decoct in water and take.
Chu Yushi stated: Chills, fatigue, or Chanzhan can cause the smallpox rash to retract and hide. Chen Zhongwen's Yigong San is suitable (see "Appearance Phase Treatment for Slow Eruption" section). Lou Shi stated: He treated Chanzhan in smallpox using Baizhu, [missing character], Danggui, and Huangqin, resulting in a cure.
[Yuan Shi] Dufu Tang: Treats Chanzhan.
Ingredient: Dafu Zi (5 qian, wrapped in flour and roasted).
Preparation: Use one cup of water, seven roots of Dengcao, decoct and take.
Adding Renshen (2 qian), Rougui (0.5 qian), Huangqi (2 qian), Juhong (1 qian), Gancao (0.5 qian), and Danggui (1 qian) to the above formula creates Fuzi Zhenyin Tang, a highly effective formula for Chanzhan and Qieya, but contraindicated for purple-black scorched/retracted rashes.
Qieya accompanied by yawning indicates Liver deficiency. The Liver belongs to Wood and prospers at Yin hour; Yin is associated with Ministerial Fire. Fire stealing Wood's Qi manifests Liver deficiency symptoms. Yang pulls upward, Yin pulls downward, leading to opening and yawning. When Yang reaches its peak and descends, and Yin reaches its peak and ascends, the mouth closes and teeth grind. Shiquan Dabu Tang is the primary formula. If Qieya occurs at the onset of fever, it differs from cases of itching, collapse, vomiting, diarrhea, and weak Spleen/Stomach; morphology and symptoms must be assessed for differentiated treatment. Frequent yawning, Qieya, and sudden oppression indicate Liver storing Wind-Heat; Qianghuo Tang (for smallpox fever) is used. Eyes rolling upward with Qieya indicates Heart Heat; Daochi San (clearing Heart) is used. Do not recklessly use Chen's acrid-hot preparations. Eyes rolling upward with Qieya indicates Heart Heat. All sores/blisters relate to Heart Fire; upward rolling is the image of Fire flaming upward; Qieya is the image of Fire Qi agitating. Daochi San plus Jiuhuang Lian and Niubangzi is used. Qieya with red face and thirst, worsening at night, suggests Dihuang Wan. Xue Ji recorded a child with smallpox Qieya, yellow face, and desire to drink. This was Yang Qi deficiency, cured by Wuwei Yigong San plus Muxiang. Later, persistent Qieya, red face, thirst, worsening at night indicated Spleen/Kidney Yin deficiency, cured by Dihuang Wan and Dabu Tang. Another child with Qieya, thirst, fluctuating white/red complexion, rapid/huge pulse, weak upon pressure (especially left Guan/Chi), indicated Kidney deficiency, cured by Dihuang Wan and Buzhong Yiqi Tang. Later, after fright, blue face, red eyes, yawning/Qieya, hand grasping collar indicated Liver Meridian deficiency-heat. Jiajian Bawei Wan decoction allowed free drinking brought immediate relief, followed by Buzhong Yiqi Tang for full recovery. A child with Qieya, thirst for cold drinks, slight constipation, chills, red rash mostly on the sides indicated Gallbladder Meridian deficiency-heat. Xiaochaihu Tang and Chaihu Maidong San (one dose each) followed by Jiawei Siwu Tang led to recovery.
Qingshen Huadu Tang: Treats Heart/Liver Fire excess causing teeth grinding.
Ingredients: Shengma, Shengdihuang, Mutong, Gancao, Fangfeng, Maidong.
Preparation: Decoct in water and take.
Renshen Chantui San: Treats Qieya, asthma/fullness, irritability, thirst (see "Smallpox Irritability").
[Qian Shi] Baishen Wan: Excellent for treating teeth grinding.
When Chanzhan and Qieya occur together, the Shaoyin channel specifically governs them; observe the root of the rash. If the rash is originally ulcerated with Chanzhan/Qieya, this is Hand Shaoyin Heart Fire. The classics say: Excess heat rots flesh. Chanzhan/Qieya signifies Fire Qi agitation. If the rash is originally black/scorched with Chanzhan/Qieya, this is Foot Shaoyin Kidney Water. Kidney color is black; it is the root of storage and sealing. Dry blackness reveals the true organ color. Kidney Qi cold manifests as trembling (Li); Chanzhan is the Kidney's primary disease. Kidney governs bone; teeth are the surplus of bone. Chanzhan causes jaw quivering and teeth grinding; Qieya is caused by Kidney cold. For these two conditions, clear if Heart Heat, warm if Kidney Cold. If the disease is deteriorated, what benefit is treatment? If Chanzhan/Qieya results from Yang Qi depletion, Dushen Tang and Shenfu Tang are very effective. If Qi/Blood fail to nourish, preventing scabbing, accompanied by oppression/restlessness, gasping when lying down, diarrhea, Chanzhan/Qieya, use Chen's Yigong San (see "Appearance Phase Slow Eruption") plus Muxiang and Danggui to rescue. Qian's method for Chanzhan/Qieya with black depression uses Baixiang Wan to purge (see "Black Depression"). Xue Ji noted: For the above symptoms, if extremities are cold, thirsty for hot drinks, with diarrhea, it is Yang Qi deficiency-cold, requiring hot tonification. If extremities are not cold, constipation, thirsty for warm drinks, it is Spleen Qi deficiency-heat, requiring regulation/tonification. If extremities are not hot, constipation, thirsty for hot drinks, it is Spleen/Stomach weakness, requiring warm tonification. A child with smallpox, Chanzhan/Qieya, limb fatigue/curling, spontaneous diarrhea, cold extremities, preference for hot drinks had Yang Qi deficiency-cold. Twelve-flavor Yigong San powder (2 qian) resolved symptoms quickly, followed by Renshen Baizhu San and Shensi San for scabbing. A 14-year-old with fluctuating red/black complexion, smallpox Chanzhan/Qieya, thirst/fever, preference for hot drinks had Yang Qi deficiency-cold. Shiquan Dabu Tang powder stopped thirst/irritation immediately, then Bazhen Tang with doubled Renshen/Huangqi. At the suppuration stage, renewed thirst/red face indicated blood/Qi deficiency after pus formation; Danggui Buxue Tang and Bazhen Tang led to scabbing. Over a month later, red face/thirst, occasional confusion, ochre-colored scars, itching, huge pulse void upon pressure indicated Blood loss; large dose Danggui Buxue Tang stabilized the patient. A child with non-suppurating rash, Chanzhan/Qieya, abdominal distension had Spleen/Stomach weakness. Sijunzi Tang, Rougui, Danggui, Huangqi, Roudoukou, followed by Shensi San led to recovery, then Tuoli San and Sijunzi Tang for scabbing. A child with itching/collapse, Chanzhan/Qieya, preference for warm drinks, non-hot extremities had Yang Qi deficiency. Shensi San resolved symptoms, then Shensi Tuoli San allowed gradual suppuration, Shiquan Dabu Tang led to scabbing. A postpartum woman with smallpox, Chanzhan/Qieya, abdominal distension/thirst, cold feet/hot body had Spleen/Stomach internal cold with external false heat. Dabu Tang plus Guizhi/Fuzi (3-4 doses), then remove Fuzi, replace with Ganjiang (2-3 doses), followed by Shensi San and Wuwei Yigong San plus Danggui/Huangqi led to recovery.
Many books list Chanzhan and Qieya together as incurable, yet skilled treatment often saves lives. This is because heat toxins fail to fully express, contending internally with righteous Qi, causing tendon/muscle agitation. Only the limbs and mouth move/open-close in the human body, representing vulnerable areas. During contention, limbs shake and teeth grind.
Wuyou San: Treats critical smallpox with Chanzhan/Qieya.
Ingredients: Renya (naturally fallen, amount unspecified, calcined to retain nature, quenched in Jiucui juice: large teeth 3 times, small teeth 2 times, ground to fine powder), Xionghuang, Zhenzhu (each 0.5 fen).
Preparation: Grind all to powder. Take 3-5 fen per dose, up to 1 qian, washed down with Lizhi decoction. Another formula includes Niuhuang 0.5 fen.
Togu Jiedu Tang: Treats Chanzhan/Qieya.
Ingredients: Zicao, Gancao, Danggui, Fangfeng, Chenpi, Chishaoyao.
Preparation: Equal parts, decoct in water and take.
Cuzhe Dan: For smallpox past day 8-9, where pus is insufficient but sudden Chanzhan/Qieya occurs.
Ingredients: Huya, Renya (one each), roasted in butter, ground fine, mixed with Renshen and Dingxiang powder, taken with milk and wine.
Didijin: Treats Chanzhan/Qieya.
Ingredients: Dog head (meat removed, marrow retained), roasted crisp in butter, ground fine, taken with strong wine decoction.